Poor condom use common among gay, bisexual black men

NEW YORK (Reuters Health) - Black men who have sex with men are more likely to report problems with broken or improperly used condoms, putting them at higher risk of contracting or transmitting HIV, according to a new study.

About 40 percent of black men who reported having sex with men within the past three months said their condoms broke or weren’t used correctly, compared to about a third of white men who had sex with men, researchers found.

The results suggest condoms may provide less protection against HIV, the virus that causes AIDS, and other sexually transmitted infections to black men who have sex with men, compared to their white counterparts.

“According to our data, condoms may be used more frequently by black (men who have sex with men), but they are also used less effectively and with more errors,” the researchers write in the journal Sexually Transmitted Infections.

Currently, more than 1.1 million people in the U.S. are living with HIV, but about 16 percent are unaware of their infection, according to the Department of Health and Human Services. More than half of new HIV infections diagnosed in the U.S. are attributed to unprotected sex between men.

The study team, led by Dr. Alfonso Hernández-Romieu from Emory University in Atlanta, writes that black men who have sex with men are about six times more likely to be diagnosed with an HIV infection, compared to white men who have sex with men.

Increased prevalence of HIV among blacks, lack of access to treatment and prevention services, stigma and discrimination may partially explain the increased likelihood of HIV diagnosis among black men who have sex with men, but condom breaks and improper condom use may also play a role, they write.

For the new analysis, the researchers used data from a study of 801 men who have sex with men, all from the Atlanta area. The men were recruited into the study between June 2010 and December 2012. They reported a same-sex sexual encounter in the past three months.

Overall, 475 men reported using a condom as the insertive sexual partner during the previous six months. Of those, about 59 percent were black and 41 percent were white.

Only about 31 percent of black men said their condoms worked effectively, compared to about 43 percent of white men.

Black men were more likely than white men to report condoms breaking, slipping during sex or slipping while pulling out. They were also more likely to report taking condoms off early and not putting on condoms at the start of sexual encounters.

The researchers also found that black men were more likely to report incorrectly using condoms, compared to white men. For example, black men were more likely to completely unroll condoms before applying them and were also more likely to use oil-based lubricants, which can weaken some condoms and cause them to break.

Black men were also more likely to report issues with how condoms fit or felt.

The researchers write that the difference in effective condom use between black and white men who have sex with men was not completely explained after taking into account usage errors and problems with condom fit and feel.

There could be other factors that they didn’t measure that influence the racial difference between groups, they add.

The researchers suggest proper condom use and reducing the use of oil-based lubricants should be incorporated into HIV prevention programs.

Companies should also consider the development of better condoms for men who have sex with men, they add.